EpistemisPersistent vulvar itching
Specialty: Gynecology and breast.
Why it occurs
- Recurrent or chronic vulvovaginal candidiasis
- Vulvar lichen sclerosus
- Contact dermatitis (due to the use of intimate soaps, deodorants, sanitary napkins, fabric softeners or latex condoms)
- Vulvar psoriasis or seborrheic eczema
- Vulvar intraepithelial neoplasia (VIN) or extramammary Paget's disease (neoplastic causes that present with chronic pruritus)
Initial workup
Detailed physical examination under good lighting (vulvoscopy with acetic acid if necessary). Vaginal smear with bacterial and mycological culture (identification of non-albicans Candida). Vulvar punch biopsy of any suspicious lesion, raised white plaque, or area of persistent erythema that does not respond to initial medical treatment within 2 to 4 weeks.
red flags
Itching that does not subside with conventional vulvar antifungals, presence of a raised, warty or persistent ulcerated lesion on the labia majora or minora, spontaneous vulvar bleeding or purulent discharge, chronic pain or associated dyspareunia.
Standard management
- Clotrimazole vulvar cream 2% (apply every 12 hours for 7-10 days) associated with Clotrimazole vaginal suppository 500 mg single dose if candidiasis is confirmed
- Clobetasol propionate cream 0.05% (apply a small amount once a day at night for 4 weeks, then gradually reduce the regimen) in case of vulvar lichen sclerosus
- Sweet almond oil or barrier pastes with zinc oxide to hydrate atrophic or eczematous vulvar skin (note: avoid high-potency corticosteroids if active infection or unbiopsied tumor lesion is suspected).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 5
- Treatment options
- 3